labarai

Yayin da kalubalen sana'a, matsalolin dangantaka, da matsalolin zamantakewa ke karuwa, damuwa na iya ci gaba. Ga marasa lafiya da aka yi musu magani a karon farko, ƙasa da rabi suna samun ci gaba mai dorewa. Sharuɗɗa game da yadda za a zaɓi magani bayan maganin rashin jin daɗi na biyu ya kasa bambanta, yana nuna cewa yayin da akwai magunguna da yawa, akwai ɗan bambanci tsakanin su. Daga cikin waɗannan magungunan, akwai mafi yawan shaidun da ke tallafawa don ƙara yawan ƙwayoyin cuta.

A cikin sabuwar gwaji, an ba da rahoton bayanan gwajin ESCAPE-TRD. Gwajin ya haɗa da marasa lafiya na 676 da ke fama da baƙin ciki waɗanda ba su amsa da muhimmanci ga aƙalla magungunan antidepressants guda biyu ba kuma suna ci gaba da shan zaɓaɓɓen masu hanawa na serotonin-norepinephrine reuptake inhibitors, irin su venlafaxine ko duloxetine; Manufar gwajin ita ce kwatanta ingancin feshin hanci na esketamine tare da ci gaba da sakin quetiapine. Ƙarshen ƙarshe na farko shine gafara a makonni 8 bayan bazuwar (amsa na gajeren lokaci), kuma mahimmin mahimmin mahimmanci na biyu ba sake dawowa ba a cikin makonni 32 bayan gafara a makonni 8.

Sakamakon ya nuna cewa babu wani magani da ya nuna tasiri mai kyau musamman, amma esketamine nasal spray ya ɗan fi tasiri (27.1% vs. 17.6%) (Hoto 1) kuma yana da ƙananan sakamako masu illa wanda ya haifar da dakatar da maganin gwaji. Amfanin magungunan biyu ya karu akan lokaci: ta mako 32, 49% da 33% na marasa lafiya a cikin Esketamine nasal spray da quetiapine ci gaba da ƙungiyoyi sun sami gafara, kuma 66% da 47% sun amsa magani, bi da bi (Hoto 2). An sami sake komawa baya kaɗan tsakanin makonni 8 da 32 a cikin ƙungiyoyin jiyya guda biyu

Wani abu mai ban mamaki na binciken shi ne cewa marasa lafiya da suka bar gwajin an kiyasta cewa suna da mummunan sakamako (watau, tare da marasa lafiya waɗanda cutar ba ta cikin gafara ko sake dawowa). Yawancin marasa lafiya sun dakatar da magani a cikin ƙungiyar quetiapine fiye da a cikin ƙungiyar esketamine (40% vs. 23%), sakamakon da zai iya yin la'akari da gajeren lokaci na dizziness da rabuwa da illa da ke hade da Esketamine nasal spray da kuma tsawon tsawon lokacin kwantar da hankali da nauyin nauyin da ke hade da quetiapine ci gaba da saki.

Gwajin budaddiyar alama ce, ma'ana marasa lafiya sun san irin magungunan da suke sha. Masu kimantawa waɗanda suka gudanar da tambayoyin asibiti don tantance ƙididdige ƙimar ƙimar damuwa na Montgomery-Eisenberg likitocin gida ne, ba ma'aikatan nesa ba. Akwai rashin ingantattun mafita ga babban makanta da son rai wanda zai iya faruwa a cikin gwaji na kwayoyi tare da tasirin psychoactive na ɗan lokaci. Sabili da haka, ya zama dole a buga bayanai game da tasirin kwayoyi akan aikin jiki da ingancin rayuwa don tabbatar da cewa bambance-bambancen da aka lura a cikin inganci ba kawai tasirin placebo bane, amma kuma cewa bambancin yana da ma'ana a asibiti.

Mahimmanci mai mahimmanci na irin waɗannan gwaje-gwajen shi ne cewa magungunan antidepressants suna neman yin tabarbarewar yanayi ba zato ba tsammani kuma suna ƙara yawan halayen suicidal a cikin ƙananan marasa lafiya. SUSTAIN 3 wani dogon lokaci ne, binciken fadada lakabin na gwajin gwaji na Phase 3 SUSTAIN, wanda a cikin abin da jimlar bin marasa lafiya na 2,769 - 4.3% an gano cewa sun sami wani mummunan yanayi na rashin lafiya bayan shekaru. Duk da haka, dangane da bayanai daga gwajin ESCAPE-TRD, irin wannan adadin marasa lafiya a cikin esketamine da ƙungiyoyin quetiapine sun fuskanci mummunar mummunar cututtuka.

Kwarewar aiki tare da feshin hanci na esketamine shima yana ƙarfafawa. Cystitis da rashin hankali sun kasance a cikin ka'idar maimakon ainihin haɗari. Hakazalika, tun da yake dole ne a yi amfani da feshin hanci a kan majinyata, za a iya hana yin amfani da shi fiye da kima, wanda kuma yana inganta yiwuwar sake dubawa akai-akai. Har zuwa yau, haɗuwa da ketamine na launin fata ko wasu magungunan da za a iya cin zarafi yayin amfani da esketamine nasal spray ba sabon abu ba ne, amma har yanzu yana da hikima don saka idanu akan wannan yiwuwar a hankali.

Menene tasirin wannan binciken ga aikin asibiti? Saƙo mafi mahimmanci shi ne cewa da zarar majiyyaci bai amsa aƙalla magungunan antidepressants guda biyu ba, yiwuwar samun cikakkiyar gafara a cikin watanni biyu tare da ƙarin magungunan magani ya kasance ƙasa. Idan aka yi la’akari da ɓacin rai na wasu marasa lafiya da kuma juriyarsu ga magunguna, ana iya raunana amincewa da jiyya cikin sauƙi. Shin mutumin da ke da babban rashin damuwa yana amsa magani? Shin majiyyaci ba shi da farin ciki a likitance? Wannan gwaji ta Reif et al. yana nuna buƙatar likitocin su nuna kyakkyawan fata da tsayin daka a cikin maganin su, ba tare da wanda ba a kula da marasa lafiya da yawa.

Duk da yake haƙuri yana da mahimmanci, haka ma saurin da ake magance matsalar damuwa. Marasa lafiya a zahiri suna son murmurewa da sauri. Tun da damar amfanin mai haƙuri a hankali yana raguwa tare da kowace gazawar maganin rashin jin daɗi, yakamata a yi la'akari da ƙoƙarin ƙoƙarin mafi inganci da farko. Idan kawai abubuwan da aka ƙayyade na abin da antidepressant za a zaɓa bayan rashin nasarar maganin miyagun ƙwayoyi biyu shine inganci da aminci, to, gwajin ESCAPE-TRD zai iya yanke shawarar cewa esketamine nasal spray ya kamata a fi son a matsayin magani na uku. Koyaya, maganin kulawa tare da feshin hanci na esketamine yawanci yana buƙatar ziyarar mako-mako ko sau biyu na mako-mako. Don haka, farashi da rashin jin daɗi na iya zama ƙwaƙƙwaran dalilai da ke shafar amfaninsu.

Esketamine hanci fesa ba zai zama kawai glutamate antagonist don shigar da aikin asibiti. Wani bincike na baya-bayan nan ya nuna cewa ketamine na tseren jini na iya zama mafi inganci fiye da esketamine, kuma manyan gwaje-gwajen kai-da-kai suna goyan bayan yin amfani da ketamine na tseren jini daga baya a cikin hanyar jiyya azaman zaɓi ga marasa lafiya da ke buƙatar maganin electroconvulsive. Da alama yana taimakawa hana kara damuwa da kuma kula da rayuwar mai haƙuri.